Hazard Analysis

Facility:

Work Area:

What is the job task being analyzed?

Analysis Date:

What are the job types of the associates who will perform this work (eg: Assembler, Tester, Engineer, Contractor, etc.):

Analysis Conducted By:

List the job tasks that are performed during this process:

Hazard Categories

Hazards with the Potential to cause a Serious Injury or Fatality (SIF)

SIF - Electrical Is the worker exposed to live exposed electrical conductors while performing this work?
Yes No

SIF-Overhead Crane Is the worker operating an overhead crane, or working in an area where they are in the fall zone of an operating overhead crane?
Yes No

SIF-Powered Industrial Vehicle Operator Does the worker operate a powered industrial vehicle (eg: forklift, order picker, powered pallet jack, man lift)?
Yes No

SIF-Pedestrian in area of PIV Does the worker work or walk in an area where powered industrial vehicles operate?
Yes No

SIF-Industrial Tools Does the worker operate powered saws, grinders, or other powered tools that have the potential to cause a severe injury or fatality?
Yes No

SIF-Robot Fields Is the worker within the full operating extent of robot or manipulator moving parts? (Consider the full operating extent, not just as the robot may be programmed.)
Yes No

SIF-Fall to Lower Level Can the worker fall to a lower level that is four feet or more, or fall into a dangerous area such as machinery at any level?
Yes No

Physical Hazards

Fall from Height Below 4 feet Could the worker fall to a lower level that is less than four feet?
Yes No

PH-Slip, Trip While performing this work, is there anything that the worker can slip or trip on:
Yes No

PH-Cut, Puncture, or Burn Is there anything that can cut, puncture, or burn the worker?
Yes No

PH-Struck by, Struck against, Caught in Is there anything that can strike the worker (moving or falling objects), that the worker can strike a body part against, or that a body part, loose clothing, jewelry, or hair can get caught in?
Yes No

Chemical Hazards

Hazardous Chemicals Is the worker exposed to any hazardous chemicals while performing this work? (A hazardous chemical is anything that requires a Safety Data Sheet. Refer to HAZCOM training.)
Yes No

Ergonomic Hazards

Ergo-Posture Does performing this work place the worker in poor postures for extended periods (more than 8 minutes at a time or more than a total of 20 minutes per hour) or are there repetitive motions performed more than 60 times per hour?
Yes No

Lifting Does the worker have to lift anything by hand that is heavier than Yaskawa standards (40 pounds within power zone, or 8 pounds from below knees, above shoulder, or that they have to reach for)?
Yes No

Force Is force required to push, pull, or grip something? (more than 10 lbs of force when pushing or pulling something straight towards or away from the body, or more than 3 pounds of force across the body, pinch force greater than 2 lbs, or grip force greater than 6 lbs) Also, are there sudden starts or stops that can be jarring to the body?
Yes No

Ergo-Vibration Is the worker exposed to vibration?
Yes No

Environmental Hazards

EH-Temperature Is the worker exposed to extreme environmental temperatures for more than 15 minutes? (Greater than 85° F or Less than 40° F):
Yes No

EF-Noise Is the worker exposed to noise greater than 85 dB? (Mark yes if someone needs to raise their voice to be heard and you don't have the ability to measure)
Yes No

Other Hazards

Other Are there any other hazards that need to be controlled?
Yes No

Personal Protective Equipment (PPE)

Personal Protective Equipment Is eye or face protection required? Yes No

Is toe or foot protection required? Yes No

Head Protection: Yes No

Hand Protection: Yes No

Hearing Protection: Yes No

Respiratory Protection: Yes No

Fall Protection: Yes No

Other PPE: Yes No

EHS Review - To be completed only by a representative of the EHS Department

EHS Review EHS Review Complete? Yes No

EHS Reviewed By:

EHS Reviewed Date: